Nishimoto Yuji, Ohbe Hiroyuki, Nakata Jun, Takiguchi Toru, Nakajima Mikio, Sasabuchi Yusuke, Isogai Toshiaki, Matsui Hiroki, Sato Yukihito, Watanabe Tetsuya, Yamada Takahisa, Fukunami Masatake, Yasunaga Hideo
Division of Cardiology Osaka General Medical Center Osaka Japan.
Department of Clinical Epidemiology and Health Economics, School of Public Health The University of Tokyo Japan.
J Am Heart Assoc. 2025 Feb 4;14(3):e037652. doi: 10.1161/JAHA.124.037652. Epub 2025 Feb 3.
It is unclear whether an intra-aortic balloon pump (IABP) or percutaneous ventricular assist device (Impella) in combination with extracorporeal membrane oxygenation (ECMO) is better.
Using the Japanese Diagnosis Procedure Combination database from September 2016 to March 2022, we identified inpatients who received an Impella or IABP in combination with ECMO (ECPella or ECMO+IABP group, respectively). The primary outcome was in-hospital mortality, and the secondary outcomes included the length of hospital stay, length of ECMO, total hospitalization cost, complications, and durable mechanical circulatory support implantations. Propensity score matching was performed to compare the outcomes between the groups.
Of 14 319 eligible patients, 590 (4.1%) received ECPella and 13 729 (96%) received ECMO+IABP. The mean age of patients was 65 years, 77% were men, and 57% had acute coronary syndrome. After propensity score matching, the patient characteristics were well balanced between the groups. The 14-day mortality rate was lower in the ECPella group than in the ECMO+IABP group (28.0% versus 36.8%; risk difference, -8.2% [95% CI, -13.8 to -2.7]), whereas there was no significant difference in in-hospital mortality between the groups (58.3% versus 56.6%; risk difference, 2.4% [95% CI, -3.5 to 8.2]). The ECPella group had a higher total hospitalization cost, increased renal replacement therapy during hospitalization, and more durable mechanical circulatory support implantations than the ECMO+IABP group.
This nationwide inpatient database study showed no significant difference in in-hospital mortality between the groups, but ECPella was associated with a higher total hospitalization cost, increased renal replacement therapy during hospitalization, and more durable mechanical circulatory support implantations than ECMO+IABP.
主动脉内球囊反搏（IABP）或经皮心室辅助装置（Impella）联合体外膜肺氧合（ECMO）哪种更好尚不清楚。
利用2016年9月至2022年3月的日本诊断流程组合数据库，我们确定了接受Impella或IABP联合ECMO的住院患者（分别为ECPella组或ECMO + IABP组）。主要结局是院内死亡率，次要结局包括住院时间、ECMO使用时间、总住院费用、并发症以及永久性机械循环支持植入情况。进行倾向评分匹配以比较两组之间的结局。
在14319例符合条件的患者中，590例（4.1%）接受了ECPella，13729例（96%）接受了ECMO + IABP。患者的平均年龄为65岁，77%为男性，57%患有急性冠状动脉综合征。倾向评分匹配后，两组患者特征均衡。ECPella组的14天死亡率低于ECMO + IABP组（28.0%对36.8%；风险差异，-8.2%[95%CI，-13.8至-2.7]），而两组的院内死亡率无显著差异（58.3%对56.6%；风险差异，2.4%[95%CI，-3.5至8.2]）。与ECMO + IABP组相比，ECPella组的总住院费用更高，住院期间肾脏替代治疗增加，永久性机械循环支持植入更多。
这项全国性住院患者数据库研究表明，两组的院内死亡率无显著差异，但与ECMO + IABP相比，ECPella与更高的总住院费用、住院期间增加的肾脏替代治疗以及更多的永久性机械循环支持植入相关。
